1 / 18

Case 2010 - 6

Case 2010 - 6. Julia Kofler, MD, Geoffrey Murdoch, MD PhD University of Pittsburgh. Clinical history. 52 yo male H/o Hodgkin lymphoma 2006 - Chemotherapy - Autologous stem cell transplant 02/2009 - Mediastinal radiation 07/2009

verlee
Télécharger la présentation

Case 2010 - 6

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Case 2010 - 6 Julia Kofler, MD, Geoffrey Murdoch, MD PhDUniversity of Pittsburgh

  2. Clinical history • 52 yo male • H/o Hodgkin lymphoma 2006 - Chemotherapy - Autologous stem cell transplant 02/2009 - Mediastinal radiation 07/2009 • 09/2009: dyspnea, cough, low-grade fever, chest wall pain and rash - Chest x-ray and CT c/w radiation pneumonitis • Mental status changes - Head CT unremarkable • One day later, patient collapsed, minimally responsive with seizure-like activity

  3. Diagnosis?

  4. VZV

  5. VZV

  6. VZV infections of the nervous system • Inflammation, hemorrhage and necrosis in spinal ganglia • Polyradiculitis • Myelitis • Meningitis • Encephalitis - Large vessel disease - Small vessel vasculopathy - Ventriculitis/periventriculits - Mixed patterns

  7. Large vessel disease • Vessel wall inflammation, necrotizing vasculitis, thrombosis • Bland or hemorrhagic infarctions in distribution of large or medium-sized arteries • Vasculopathy with fibrointimal proliferation but without inflammation • Immunocompetent and immunosuppressed patients Kleinschmidt-DeMasters, Arch Pathol Lab Med 2001

  8. Small vessel vasculopathy • Variable lymphocytic infiltrate and endothelial swelling • Often associated with infection of oligodendrocytes • Mixed ischemic/demyelinating lesions near cortical gray/whitejunction • Intranuclear viral inclusionsmore readily identified • Lesions often lack significant inflammation Kleinschmidt-DeMasters, Arch Pathol Lab Med 2001

  9. Ventriculitis/periventriculitis • Rare in pure form • Infection of ependymal cells VZV ISH Kleinschmidt-DeMasters, Arch Pathol Lab Med 2001

  10. Final diagnosis • Varicella zoster radiculitis, meningitis and vasculitis associated with intraparenchymal hemorrhage

  11. References • Kleinschmidt-DeMasters BK, Gilden DH. Varicella zoster virus infections of the central nervous system. Clinical and pathologic correlates. Arch Pathol Lab Med 2001; 125:770-780 • Kleinschmidt-DeMasters BK, Amlie-Lefond C, Gilden DH. The patterns of Varicella zoster virus encephalitis. Hum Pathol 1996; 27:927-938. • Gilden D, Cohrs RJ, Mahalingham R, Nagel MA. Varicella zoster virus vasculopathies: Diverse clinical manifestations, laboratory features, pathogenesis and treatment. Lancet Neurol 2009; 8:731-740.

More Related